Cited by 1,326Pharmaceutical Practices and Patient OutcomesBalance, Gait, and Falls PreventionFrailty in Older Adults

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Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons

Woolcott, John C.·2009·Archives of Internal Medicine

DOI 10.1001/archinternmed.2009.357

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Abstract

BACKGROUND: There is increasing recognition that the use of certain medications contributes to falls in seniors. Our objective was to update a previously completed meta-analysis looking at the association of medication use and falling to include relevant drug classes and new studies that have been completed since a previous meta-analysis. METHODS: Studies were identified through a systematic search of English-language articles published from 1996 to 2007. We identified studies that were completed on patients older than 60 years, looking at the association between medication use and falling. Bayesian methods allowed us to combine the results of a previous meta-analysis with new information to estimate updated Bayesian odds ratios (ORs) and 95% credible intervals (95% CrIs) RESULTS: Of 11 118 identified articles, 22 met our inclusion criteria. Meta-analyses were completed on 9 unique drug classes, including 79 081 participants, with the following Bayesian unadjusted OR estimates: antihypertensive agents, OR, 1.24 (95% CrI, 1.01-1.50); diuretics, OR, 1.07 (95% CrI, 1.01-1.14); beta-blockers, OR, 1.01 (95% CrI, 0.86-1.17); sedatives and hypnotics, OR, 1.47 (95% CrI, 1.35-1.62); neuroleptics and antipsychotics, OR, 1.59 (95% CrI, 1.37-1.83); antidepressants, OR, 1.68 (95% CrI, 1.47-1.91); benzodiazepines, OR, 1.57 (95% CrI, 1.43-1.72); narcotics, OR, 0.96 (95% CrI, 0.78-1.18); and nonsteroidal anti-inflammatory drugs, OR, 1.21 (95% CrI, 1.01-1.44). The updated Bayesian adjusted OR estimates for diuretics, neuroleptics and antipsychotics, antidepressants, and benzodiazepines were 0.99 (95% CrI, 0.78-1.25), 1.39 (95% CrI, 0.94-2.00), 1.36 (95% CrI, 1.13-1.76), and 1.41 (95% CrI, 1.20-1.71), respectively. Stratification of studies had little effect on Bayesian OR estimates, with only small differences in the stratified ORs observed across population (for beta-blockers and neuroleptics and antipsychotics) and study type (for sedatives and hypnotics, benzodiazepines, and narcotics). An increased likelihood of falling was estimated for the use of sedatives and hypnotics, neuroleptics and antipsychotics, antidepressants, benzodiazepines, and nonsteroidal anti-inflammatory drugs in studies considered to have "good" medication and falls ascertainment. CONCLUSION: The use of sedatives and hypnotics, antidepressants, and benzodiazepines demonstrated a significant association with falls in elderly individuals.

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“Medication use, particularly polypharmacy and use of a variety of types of medications are associated with fall risk [48–53].”
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Treatment strategies for insomnia in Japanese primary care physicians’ practice: A Web-based questionnaire survey
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Guía de atención integral para la detección temprana y diagnóstico del episodio depresivo y trastorno depresivo recurrente en adultos. Atención integral de los adultos con diagnóstico de episodio depresivo o trastorno depresivo recurrente
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“In addition to the ADEs described in the aforementioned studies, medication use can also precipitate other AEs such as falls in older adults.(4,6) Ermer and Harder(5) found that a number of contributing factors, rather than a single factor, led to falls.”
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Psychotropes et sujet âgé
Desmidt, T., & Camus, V. (2011) · Encyclopédie médico-chirurgicale. Psychiatrie · doi:10.1016/s0246-1072(11)55039-4 · Cited by 3
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“However, whether anti-hypertensive drug use is a risk factor for fall or not is still in debate [36, 37].”
Background
Opioid intake prior to admission is not increased in elderly patients with low‐energy fractures: A case–control study in a German hospital population
Schwarzer, A., Kaisler, M., Kipping, K., Seybold, D., Rausch, V., Maier, C., & Vollert, J. (2018) · European Journal of Pain · doi:10.1002/ejp.1247 · Cited by 4
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Background
Pharmacistʼs Role in an Interdisciplinary Falls Clinic
Flores, E. K., Henry, R., & Stewart, D. W. (2011) · Southern Medical Journal · doi:10.1097/smj.0b013e318200c1ec · Cited by 3
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“However, a meta-analysis [40] of the impact of”
Background
Prevention of Falls in Older Adults
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“We assessed falls risk as opposed to history of falling and did not include measures of other fall risk factors, such as medication (Woolcott et al., 2009), and depression (Iaboni and Flint, 2013).”
Background
Fall among hospitalized patients and the use of drugs that increase the risk / Queda entre pacientes hospitalizados e o uso de medicamentos que potencializam o risco
Meireles, I. B., Pessanha, C. M., Ramos, A. C. D. A., da Silva, R. C. L., da Silva, A. S., & da Silva, R. F. A. (2021) · Revista de Pesquisa Cuidado é Fundamental Online · doi:10.9789/2175-5361.rpcfo.v13.11186 · Cited by 3
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“According to the study of Woolcott et al. (30) antidepressants, neuroleptics, antipsychotics, benzodiazepines, sedative-hypnotics, and antihypertensive drugs were shown as the drugs that increase the risk of falling the most.”
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Background
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“Conflicting results regarding the effects of beta-blockers on falls have been previously published [21, 62–64], and deprescribing FRIDs in isolation has not been shown to reduce falls in older adults in previous meta-analyses [65].”
Result
Development and Delphi consensus validation of the Medication-Related Fall screening and scoring tool
Saeed, D., Carter, G., Miller, R., Darcy, C., Miller, K. H., Madden, K., McKee, H., Agnew, J., Crawford, P., & Parsons, C. (2024) · International Journal of Clinical Pharmacy · doi:10.1007/s11096-024-01734-w · Cited by 3
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Result
The interactive walkway provides fit‐for‐purpose fall‐risk biomarkers in the elderly: Comparison of zolpidem and suvorexant
Koopmans, I. W., Geerse, D. J., de Ridder, L., Roerdink, M., Juachon, M. J., Muehlan, C., Dingemanse, J., van Gerven, J., Groeneveld, G. J., & Zuiker, R. G. J. A. (2024) · Clinical and Translational Science · doi:10.1111/cts.13875 · Cited by 3
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“…of the injury (location of fall, aetiology of fall), comorbidities, medications (psychiatric medications, antiepileptics, opioids, NSAIDs [27,28], cardiovascular medications, insulin, and osteoporosis medications), different groups of anticoagulants, alcohol intoxication, clinical outcomes…”
An Evaluation of Potential Inappropriate Prescribing Among Older Persons in Nigeria
Saka, S. A., Oosthuizen, F., & Nlooto, M. (2018) · Global Journal of Health Science · doi:10.5539/gjhs.v10n11p28 · Cited by 3
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“medication review.(2,3,8) Fall risk should then be further assessed in eligible patients using the Centers for Disease Control and Preventions Three Key Questions(9):”
Background
Von Anämie bis Zuckerkrankheit – Sturzursachen
Galliardt, M. (2021) · physiopraxis · doi:10.1055/a-1540-2069 · Cited by 3
Pharmakotherapie und geriatrische Syndrome
Burkhardt, H. (2013) · Springer eBooks · doi:10.1007/978-3-642-34873-0_3 · Cited by 3
The Effect of Thiazides on Bone Markers, Bone Mineral Density and Fractures
Caudarella, R., Vescini, F., Rizzoli, E., & Ulivieri, F. M. (2015) · Clinical Reviews in Bone and Mineral Metabolism · doi:10.1007/s12018-015-9190-0 · Cited by 3
“[84] carried out a meta-analysis without observing a significant association between thiazides use and falling.”
Background
Sturz im Alter
Gschwind, Y. J., Bridenbaugh, S. A., & Kressig, R. W. (2013) · Springer eBooks · doi:10.1007/978-3-7091-1581-7_25 · Cited by 3
Quality analysis of research on the use of benzodiazepines by elderly patients in the emergency room:a systematic review
Couto, A. T. R., Silva, D. T., Silvestre, C. C., de Lyra, D. P., & Quintans‐Júnior, L. J. (2013) · European Journal of Clinical Pharmacology · doi:10.1007/s00228-012-1439-7 · Cited by 3
“Several studies in this review showed a relationship between high BZD consumption and falls [20, 22, 35], which is consistent with the reports in the literature.”
Result
The effects of acute treatment with paroxetine, amitriptyline, and placebo on the equilibrium function in healthy subjects: A double-blind crossover trial
Miyata, S., Noda, A., Iwamoto, K., Takahashi, M., Hara, Y., Kojima, J., Iidaka, T., & Ozaki, N. (2013) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2013.813551 · Cited by 3
“According to their pharmacological profi les, antidepressants can impair alertness and sense of equilibrium (Woolcott et al. 2009).”
Background
Avaliação dos riscos de queda de pacientes em uso de medicamentos prescritos em hospital universitário
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BackgroundInfluential
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Background
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Authors: Woolcott, J. C.
Affiliations: University of British Columbia (CA)
Corresponding author: Woolcott, John C.
ORCID: Woolcott, John C.
Venue: Archives of Internal Medicine
Publisher: American Medical Association (AMA)
Published: 2009-11-01
Volume: 169
Issue: 21
Pages: 1952
ISSN: 0003-9926 (ISSN-L)
DOI: 10.1001/archinternmed.2009.357
OpenAlex: W2094113973
Cited by: 1,326
References: 54
Citations by year: 2026: 42 · 2025: 42 · 2024: 67 · 2023: 57 · 2022: 70 · 2021: 116 · 2020: 93 · 2019: 122 · 2018: 107 · 2017: 99 · 2016: 80 · 2015: 89 · 2014: 83 · 2013: 83 · 2012: 71
FWCI: 5.97
Type: journal article
Language: en
Open access: closed
Locations: Archives of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
UEA Digital Repository (University of East Anglia) (submittedVersion)
Funders: Canadian Institutes of Health Research
Topics: Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
Keywords: falls in older adults, fall risk, antihypertensive drugs, diuretics, beta-blockers, sedative-hypnotic drugs, antidepressants, benzodiazepines, narcotics, nonsteroidal anti-inflammatory drugs, drug safety, fall prevention, geriatric pharmacology, polypharmacy
MeSH terms: Accidental Falls, Aged, Aged, 80 and over, Anti-Inflammatory Agents, Non-Steroidal, Antidepressive Agents, Bayes Theorem, Benzodiazepines, Cardiovascular Agents, Cross-Sectional Studies, Diuretics, Humans, Hypnotics and Sedatives, Narcotics, Risk Factors, Sensitivity and Specificity, Antipsychotic Agents, Odds Ratio, Case-Control Studies, Randomized Controlled Trials as Topic

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Meta-analysis of the Impact of 9 Medication Classes on Falls in Elderly Persons

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